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Handchir Mikrochir Plast Chir 2024; 56(06): 409-419
DOI: 10.1055/a-2407-9254
Übersichtsarbeit

Autologe Brustrekonstruktion und Bestrahlung: Konsensus-Bericht der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie (DAM)

Autologous Breast Reconstruction and Radiotherapy: Consensus Report of the German-Speaking Society for Reconstructive Microsurgery (GSRM)
Albrecht Heine-Geldern
1   Klinik für Plastische Chirurgie, Hand- und Rekonstruktive Mikrochirurgie, Handtrauma- und Replantationszentrum, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
,
Christoph Hirche 
1   Klinik für Plastische Chirurgie, Hand- und Rekonstruktive Mikrochirurgie, Handtrauma- und Replantationszentrum, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
,
Thomas Kremer
2   Klinik für Plastische und Handchirurgie mit Schwerbrandverletztenzentrum, Klinikum St Georg, Leipzig, Germany
,
Kristina Lössl
3   Universitätsklinik für Radio-Onkologie, Inselspital Universitatsspital Bern, Bern, Switzerland
,
Alexander D. Bach
4   Klinik für Plastische und Ästhetische Chirurgie, Handchirurgie - Wiederherstellungschirurgie, St.-Antonius-Hospital gGmbH Eschweiler, Eschweiler, Germany
,
Elisabeth Russe
5   Abteilung für Plastische, Ästhetische und Rekonstruktive Chirurgie, Aö. KH der Barmherzigen Brüder, Salzburg, Austria
,
Hisham Fansa
6   Klinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Städtische Kliniken Bielefeld Mitte, Bielefeld, Germany
,
Justus P. Beier
7   Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen, Aachen, Germany
,
Yves Harder 
8   Plastische, Rekonstruktive und Ästhetische Chirurgie, Repubblica e Cantone Ticino Ente Ospedaliero Cantonale, Viganello – Lugano, Switzerland
,
Arash Momeni 
9   Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, Stanford, United States
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Zusammenfassung

Die autologe Brustrekonstruktion nach Mastektomie mittels freien Lappenplastiken (kurz: autologe Brustrekonstruktion) zeigt im Vergleich zur Implantat-basierten Rekonstruktion günstige klinische Langzeitergebnisse und eine höhere Patientenzufriedenheit. Traditionell galt die adjuvante Strahlentherapie als relative Kontraindikation für die sofortige autologe Brustrekonstruktion aufgrund der unvorhersehbaren Strahlenfolgen. Moderne adjuvante Strahlentherapien (PMRT) konnten jedoch akute und chronische Strahlenschäden deutlich reduzieren. Dennoch zögern Plastische Chirurgen immer noch, Patientinnen, die eine adjuvante Strahlentherapie benötigen, eine sofortige autologe Brustrekonstruktion anzubieten. In jüngster Zeit gibt es jedoch Hinweise auf einen Paradigmenwechsel, der eine solche Rekonstruktion trotz anschließender Strahlentherapie befürwortet. Im Rahmen eines Konsensus-Workshops der 44. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie (DAM) in Bern (Schweiz) wurde die Evidenz zur PMRT und autologer Brustrekonstruktion dargestellt und Konsensus-Formulierungen zum zukünftigen chirurgischen Management und zur zeitlichen Koordinierung erarbeitet. Dabei wurde betont, dass das Ziel jeder Rekonstruktion eine weiche und möglichst sensible Brust sein sollte, welche durch ein sicheres Verfahren eine bestmögliche Symmetrie in Form und Größe zur nicht betroffenen Gegenseite schafft. Es wurde konsentiert, dass die Erhaltung des originären Haut- und Weichteilmantels im Sinne einer hautsparenden oder sogar Mamillen-Areolen-Komplex (MAK) sparenden Mastektomie bei gleicher onkologischer Sicherheit die besten ästhetischen Ergebnisse erbringt. Abschließend konnte ein Konsens gefunden werden, dass eine PMRT und die zu erwartenden Strahlenfolgen entgegen dem ursprünglichen Meinungsbild vor dem Workshop nicht mehr eine Kontraindikation für eine autologe Sofortrekonstruktion darstellen sollten.

Abstract

Autologous postmastectomy breast reconstruction is associated with favourable long-term clinical outcomes and superior patient-reported outcomes (PROMs) compared with implant-based reconstruction. However, adjuvant radiotherapy has traditionally been considered a relative contraindication to immediate flap-based reconstruction due to its unpredictable effects on the reconstructive outcome. While modern adjuvant postmastectomy radiotherapy (PMRT) has been able to significantly reduce acute and chronic radiation-induced complications, plastic surgeons still hesitate to offer immediate autologous reconstruction to patients expected to undergo adjuvant radiotherapy. More recently, evidence has emerged suggesting a paradigm shift in favour of immediate autologous reconstruction despite subsequent radiotherapy. At the 44th Annual Meeting of the German-speaking Society for Reconstructive Microsurgery (GSRM) in Bern, Switzerland, a workshop discussed the literature on PMRT and autologous breast reconstruction, aiming to establish consensus among the participants. Several areas of agreement were identified, including the goals of postmastectomy reconstruction, specifically the creation of a soft and sensitive breast symmetrical in shape and size to the unaffected breast via the safest procedure possible. The importance of preserving the maximum amount of native breast skin envelope through skin- and nipple-sparing approaches was emphasised. Finally, a consensus was reached that PMRT should no longer be considered a contraindication to immediate autologous breast reconstruction.

Schlüsselwörter

Autologe Brustrekonstruktion - Post-Mastektomie-Bestrahlung - Strahlenfolgen - Mammakarzinom

Keywords

autologous breast reconstruction - radiation-induced effect - breast cancer - postmastectomy radiotherapy


Publication History

Received: 07 May 2024

Accepted: 29 August 2024

Article published online:
02 October 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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